PI-RADS 4 or more: Active Surveillance no more

June 30, 2016

The introduction of multiparametric Magnetic Resonance Imaging (mpMRI) has improved the diagnosis and risk stratification of intermediate and high-risk prostate cancer. In addition to diagnosis, mpMRI has increasing become a useful tool for monitoring prostate cancer risk of patients on active surveillance (AS) programs. A significant proportion of men on AS programs have suspicious lesions on mpMRI [1]. Accordingly, repeat mpMRI provides means of non-invasive assessment with the potential for fusion biopsy and preferential sampling of prostate cancer tissue. In 2012, the Prostate Imaging Reporting and Data System (PI-RADS) introduced standardized reporting of prostate mpMRI. PI-RADS 4 and 5 lesions have been classified as "clinically significant cancer is likely to be present" and "clinically significant cancer is highly likely" respectively. PI-RADS 4 and 5 lesions are being increasing correlated with intermediate and high-grade prostate cancer. As recently discussed in: "Gleason Pattern 4: Active Surveillance no more" [2], patients with intermediate-risk prostate cancer are not suitable for AS. In light of this, the presence of PI-RADS 4 or 5 lesions on men enrolled to AS programs for prostate cancer warrants concern. This article is protected by copyright. All rights reserved.

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